Abstract
BackgroundTo retrospectively review the outcome of patients with primary or secondary oligometastatic lung cancer, treated with hypofractionated Tomotherapy.MethodsBetween April 2007 and June 2011, a total of 33 patients with oligometastatic intrapulmonary lesions underwent hypofractionated radiotherapy by Tomotherapy along with appropriate systemic therapy. There were 24 primary, and 9 secondary lung cancer cases. The radiation doses ranged from 4.5 to 7.0 Gy per fraction, multiplied by 8–16 fractions. The median dose per fraction was 4.5 Gy (range, 4.5-7.0 Gy), and the median total dose was 49.5 Gy (range, 45–72 Gy). The median estimated biological effective dose at 10 Gy (BED10) was 71.8 Gy (range, 65.3–119.0 Gy), and that at 3 Gy (BED3) was 123.8 Gy (range, 112.5–233.3 Gy). The mean lung dose (MLD) was constrained mainly under 1200 cGy. The median gross tumor volume (GTV) was 27.9 cm3 (range: 2.5–178.1 cm3).ResultsThe median follow-up period was 25.8 months (range, 3.0–60.7 months). The median overall survival (OS) time was 32.1 months for the 24 primary lung cancer patients, and >40 months for the 9 metastatic lung patients. The median survival time of the patients with extra-pulmonary disease (EPD) was 11.2 months versus >50 months (not reached) in the patients without EPD (p < 0.001). Those patients with smaller GTV (≦27.9 cm3) had a better survival than those with larger GTV (>27.9 cm3): >40 months versus 12.85 months (p = 0.047). The patients with ≦2 lesions had a median survival >40 months, whereas those with ≧3 lesions had 26 months (p = 0.065). The 2-year local control (LC) rate was 94.7%. Only 2 patients (6.1%) developed ≧grade 3 radiation pneumonitis.ConclusionUsing Tomotherapy in hypofractionation may be effective for selected primary or secondary lung oligometastatic diseases, without causing significant toxicities. Pulmonary oligometastasis patients without EPD had better survival outcomes than those with EPD. Moreover, GTV is more significant than lesion number in predicting survival.
Highlights
Many cancer patients succumb to either primary or secondary lung cancer
This study reports our experience of hypofractionated Tomotherapy for the treatment of oligometastatic primary or secondary lung cancer
Hypofractionated Tomotherapy with conventional immobilization cast may be as good as stereotactic body radiation therapy (SBRT) with extreme hypofractionation
Summary
Many cancer patients succumb to either primary or secondary lung cancer. Primary lung cancer is the leading cause of cancer-related mortality all over the world. It results in 20% of all cancer deaths in Taiwan, and approximately 25–30% in the United States [1]. Given the continued improvement in systemic therapy for lung cancer treatment, the role of local therapy may be more important because oligometastasis or oligorecurrence states are more frequent in the era of good but not curative systemic therapy [2]. Before the cancer cells acquire the ability to spread throughout the whole body, local resection or ablative therapy with curative intent may reduce the tumor burden and prolong the lives of patients. To retrospectively review the outcome of patients with primary or secondary oligometastatic lung cancer, treated with hypofractionated Tomotherapy
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